"But Doc, I felt it go, and when I see the chiro they put it back in and I hear it pop in to place. " is the normal response when I start explaining that backs don't go out. I would like to try to take a few minutes to explain what is happening when we suffer from acute back pain and why joint manipulations or adjustments might work. The human body is very complex, but I will try to lay this out as concisely as I can.
First of the human body is very robust, that is why we can do so many things that are bad for us and survive for as long as we do. The spine itself is very robust. It is a series of bones that have cartilaginous disks fused to them, these disks to not "slip" around, they compress and stretch depending on which way the spine is bending and twisting (contrary to popular belief, the spine is meant to bend and twist in almost all directions. Most people are just doing it without balanced muscle tension to support the joints.) So when you bend or twist without the proper muscle tensions, you may be putting compressive forces on the disk which may stress or tear some of the outer fibers, do that long enough and you may have a significant problem.
But each time we put a significant unbalanced force on a disk your body is likely to respond by changing muscle tone, some muscles will become less responsive to try to give the back some time to heal. This quick muscle tone change, a protective mechanism, is your back "going out", this often will lead to the joints and bones being out of alignment (which might be where the phrase going out came from), which requires the muscles to re-balance tension to bring the bones back into alignment. your bones only do what the msucle and fascia make them do. It is not that joints or disks go out (there are some exceptions to this but people tend to call them what they actually are- herniations, listhesis, fractures or dislocations).
Whats happening when my back gets cracked?
When joints are popping it is because you are taking a joint through a range of motion that it hasn't been in a while and a small air pockets are released, POP! when you stretch the ligaments in the area it sends signals to the brain that may help reset muscle tone in the area, often the injury happens because the body is not "tuned" to do what is should be, so even if popping the joints brings you back to where you were before injury, you are still moving through a body that is injury prone.
So what should I do?
If you are reading this its probably too late to tell you that prevention is the best step, and contrary to some of the discussion in the physical therapy world, prevention is possible. So what to do depends on what happened, your history, your body type, and how much pain you are in and your knowledge of the body. There are a hundred different methods of rehabilitation, I am personally partial to myofascial release and training for full body control to develop a balance tension of muscle around the joints. Every body has a unique set of problems, so seeking professional help from somebody that understands human movement is likely the best way to improve the situation. If you have a fair understanding of anatomy or exercise there are thousands of online resources with information. The most extensive free catalog of corrective exercise I have seen is the youtube channel offered by Functional Patterns, for access click here. Search for planks, prone retractions, posture, MFR +body part and you will have access to enough content to get you moving in the right direction .
Why do I prefer myofascial release over joint mobilization? The traditional model of human movement infers that we are a bunch of bones stacked on top of each other with muscles connecting them. I think it is more accurate to say we are a big bag of muscle with a bunch of bones floating in it. The emphasis to all movement problems should be getting out bags of muscle support bones and joints better. Don't get me wrong, occasionally joint mobilization helps, but the joints are in jeopardy because the muscles do not work in regard to gravity as well as they should.
Thank you for taking the time to read this, if you have any questions, comments or concerns, please share them. Problems start to be fixed by understanding that there are problems and the nature of the problems. Educating yourself is vital in the road to recovery.
James is dedicated to helping the Portland area decrease pain and improve performance. He believes education is an important factor in solving your problems.